Medicare's Negotiated Prices for Ozempic and 14 Other Drugs Take Effect Jan. 1; Medicare Open Enrollment Ends Dec. 7

EASTON, MARYLAND — Starting Jan. 1, Medicare's negotiated prices take effect for 15 more prescription drugs, including Ozempic, Rybelsus and Wegovy, the inhaler Trelegy Ellipta and the diabetes pills Janumet and Tradjenta, according to the Centers for Medicare & Medicaid Services.

The agreed prices for a 30-day supply run 38% to 85% below the drugs' 2024 list prices, a CMS fact sheet shows. Ozempic, Rybelsus and Wegovy, which CMS treats as one selected drug, carry a negotiated price of $274 for a 30-day supply, against a 2024 list price of $959.

The prices reach people through their Medicare drug coverage. By law, Medicare prescription drug plans, including stand-alone Part D plans and Medicare Advantage plans with drug coverage, must include the selected drugs on their formularies, CMS says, and each drug company must make the negotiated price available to eligible people and to the pharmacies and mail-order services that dispense the drug. CMS estimates that people enrolled in Medicare prescription drug coverage would save about $685 million in out-of-pocket costs under the standard benefit design once the prices take effect.

Across the country, about 5.3 million of the 53 million people with Part D coverage were dispensed these drugs in 2024, according to CMS, and they spent $1.7 billion out of pocket on them. The drugs treat conditions such as cancer, diabetes and asthma. In Talbot County, about 30% of residents are 65 or older, the highest share of any county in Maryland, according to the county's Commission on Aging.

Two other drug-cost limits change Jan. 1. No Medicare drug plan may have a deductible above $700 in 2027, up from $615 in 2026. And once a person's out-of-pocket spending on covered Part D drugs reaches $2,400 in 2027, up from $2,100 in 2026, catastrophic coverage begins and the person pays nothing out of pocket for covered Part D drugs for the rest of the calendar year, according to Medicare.gov.

Four drugs from Medicare's first round of negotiated prices, Stelara, Entresto, Xarelto and the NovoLog and Fiasp insulins, are listed for removal from the program's drug list effective Jan. 1, 2027. CMS removes a drug from the list in certain circumstances, such as when the Food and Drug Administration has approved a generic or licensed a biosimilar version and it is on the market.

The figures in the table come from the Centers for Medicare & Medicaid Services fact sheet on negotiated prices for 2027. User counts are rounded by CMS; list prices are wholesale prices for a 30-day supply based on 2024 fills.

People who want to change their coverage for 2027 during Medicare Open Enrollment have until Dec. 7. Medicare Open Enrollment runs Oct. 15 through Dec. 7, and changes take effect Jan. 1 as long as the plan gets the enrollment request by Dec. 7.

Talbot County's State Health Insurance Assistance Program office, reached at 410-822-2869, offers one-on-one help for people who are new to Medicare or looking to change their coverage. SHIP does not sell insurance, and calls are free and confidential, according to the Maryland Department of Aging.