The biggest change to Medicare drug spending in decades is price negotiation. Here is how it works and how it interacts with the data on this site.
The basics
The Inflation Reduction Act (2022) gave Medicare authority to negotiate prices directly with manufacturers for a subset of its highest-spend drugs that lack generic or biosimilar competition. CMS publishes the selected drugs and the agreed “maximum fair prices.”
The first 10 negotiated drugs
The first round targeted drugs that sit right at the top of the Part D spending list — which is exactly why they were chosen:
| Drug | Why it was selected |
|---|---|
| Eliquis | #1 by total Part D spending |
| Jardiance | Top-3 diabetes drug, fast-growing |
| Xarelto | High-spend anticoagulant |
| Januvia | Long-established diabetes drug |
| Farxiga | High-spend SGLT2 inhibitor |
The list also included Entresto, Enbrel, Imbruvica, Stelara and the Fiasp/NovoLog insulins. The negotiated prices take effect in 2026.
Why the data still shows pre-negotiation spending
The current CMS file is data year 2023, which predates the negotiated prices. So the spending figures on this site reflect the un-negotiated market. As CMS releases 2026 and later data, you should expect lower per-unit spending on the negotiated drugs versus their prior trend — a natural experiment worth watching in future fastest-rising-price and per-unit rankings.
The bottom line
Negotiation concentrates on the same drugs that dominate spending, so its effect on the program total could be meaningful even with a short initial list. We will reflect it as new annual data is published.
This is general policy information, not medical, legal or pricing advice. Source: CMS Medicare Part D Spending by Drug, data year 2023, U.S. public domain; CMS Medicare Drug Price Negotiation Program announcements.