Medicare Drug Price Negotiation: Early Wins and What’s Next
The Inflation Reduction Act of 2022 (IRA) is already delivering on its promise to lower prescription drug costs for Medicare beneficiaries. A recent analysis from KFF reveals that the IRA’s coverage requirement – mandating all Medicare Part D plans cover drugs selected for price negotiation – is leading to improved access to vital medications. This isn’t just about lower prices; it’s about ensuring people can actually get the drugs they need.
Expanding Coverage: The First 10 Negotiated Drugs
As of January 1, 2026, the first 10 drugs subject to Medicare price negotiation are seeing increased coverage. Before the IRA’s requirements took effect, coverage varied significantly between Part D plans. Now, all plans must include these drugs, in all dosages and forms. The KFF analysis highlights substantial gains in coverage for insulin products like Fiasp and NovoLog, as well as for the cancer drug Imbruvica. For example, Fiasp coverage jumped from 24% of Part D enrollees in 2025 to full coverage in 2026.
Looking Ahead: The Next Wave of Negotiated Drugs and Wegovy
The impact won’t stop there. A second set of 15 drugs will have negotiated prices taking effect in 2027 and the IRA’s coverage requirement will again expand access. One drug in particular is drawing significant attention: Wegovy, a GLP-1 medication used for obesity and cardiovascular disease risk reduction.
Currently, Medicare Part D plans generally only cover Wegovy for cardiovascular disease, due to restrictions on covering drugs for weight loss. However, the Trump administration is exploring a voluntary model to expand coverage for GLP-1s to treat obesity, potentially opening access to Wegovy for a wider range of beneficiaries starting in 2027. The IRA’s coverage requirement will then ensure that all Part D plans cover Wegovy for Medicare-covered uses.
Beyond Wegovy: More Drugs Gaining Wider Access
Wegovy isn’t the only drug poised for increased coverage. Other drugs selected for negotiation in the second round, like Austedo and Austedo XR (for involuntary movement disorders), Otezla (for psoriasis and psoriatic arthritis), and Breo Ellipta (for asthma and COPD), currently aren’t covered by all Part D plans. The IRA will change that, bringing these medications to more beneficiaries. Several drugs already benefit from broad coverage due to being part of Medicare’s “protected classes,” including antineoplastics like Xtandi, Pomalyst, Ofev, Ibrance, and Calquence, and the antipsychotic Vraylar.
This analysis was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.
Frequently Asked Questions
What is the Medicare Drug Price Negotiation Program?
This program, part of the Inflation Reduction Act, allows Medicare to negotiate the prices of some high-cost prescription drugs, aiming to lower costs for beneficiaries and the program itself.
How does the IRA improve drug coverage?
The IRA requires all Medicare Part D plans to cover drugs selected for price negotiation, ensuring broader access to these medications.
What is the status of Wegovy coverage under Medicare?
Currently, Wegovy is generally covered only for cardiovascular disease. A voluntary model is being considered to expand coverage for obesity treatment starting in 2027.
Pro Tip: Check with your specific Part D plan to understand your coverage for negotiated drugs and any potential cost-sharing requirements.
The IRA’s impact on drug pricing and access is still unfolding, but these early results are encouraging. As more drugs are added to the negotiation program, Medicare beneficiaries can expect continued improvements in affordability and coverage.
