CMS announces 15 drugs included in the third round of Medicare Drug Price Negotiation program  – January 28, 2026

Diabetes-related drug includes Lilly’s GLP-1 RA Trulicity (dulaglutide), whose prices will take effect in 2028; BI/Lilly’s DPP-4 inhibitor Tradjenta pricing to be renegotiated

The Centers for Medicare & Medicaid Services (CMS) just announced the 15 drugs that will be covered under Medicare Part D in the second cycle of negotiations from the Medicare Drug Price Negotiation Program (MDPNP). The drugs include one diabetes-related product, Lilly’s GLP-1 RA Trulicity (dulaglutide). Negotiated prices of the third round will take effect in 2028.

BI/Lilly’s DPP-4 inhibitor Tradjenta (linagliptin), which was included in the second round of MDPNP, will also be renegotiated, with the new price to take effect in 2027.

Medicare expenditures for Trulicity totaled $4.9 billion in 2024-2025

The 15 drugs selected for the third round of MDPNP[1] include medications for cancer, autoimmune diseases, asthma, chronic obstructive pulmonary disease (COPD), HIV, psychiatric diseases, and more. Between November 2024 to October 2025, these drugs accounted for $27 billion (~6%) in total prescription spending under Medicare Part B and Part D and treated 1.8 million beneficiaries. Among these, Lilly’s Trulicity (dulaglutide), GLP-1 RA for T2D, accounted for the highest spending of $4.9 billion and treated 617,000 patients.

CMS also released a list of top 50 drugs eligible for negotiation, first 15 of which were selected for third round of MDPNP. This includes BI/Lilly’s Synjardy/Synjardy XR (empagliflozin and metformin for T2D), which totaled $603 million in total Medicare Part B and Part D expenditure.

Figure 1. Total drug costs and number of Medicare enrollees prescribed between November 2024 to October 2025

Source: CMS, Fact Sheet for Medicare Drug Price Negotiation Program: Selected Drugs for Initial Price Applicability Year 2028

First two rounds of MDPNP lowered prices of GLP-1 RAs, DPP-4 inhibitors, SGLT-2 inhibitors, and insulin by 66-85%

In 2023, CMS said that Part D beneficiaries accrued $18.9 billion in out-of-pocket costs for all Part D drugs covered. The Inflation Reduction Act of 2022 established MDPNP, which allows Medicare to directly negotiate prices of high-cost drugs covered by Medicare Parts B or D without generic or biosimilar competition. Small molecules are eligible for negotiation after at least seven years on the market post-FDA approval and biologics after at least 11 years post-approval.

In August 2023, CMS announced 10 drugs included in the first round of MDPNP, four of which were diabetes-related: (i) AstraZeneca’s SGLT-2 inhibitor Farxiga; (ii) Merck’s Januvia (sitagliptin); (iii) BI/Lilly’s Jardiance (empagliflozin); and (iv) Novo Nordisk’s rapid-acting insulins NovoLog and Fiasp. Negotiated prices were announced in August 2024, with discounts ranging from 66-79%.

CMS announced the next 15 drugs included in the second round of MDPNP in January 2025, including three of which that were diabetes- or obesity-related: Novo Nordisk’s Ozempic (semaglutide for T2D), Wegovy (semaglutide for obesity), and Rybelsus (oral semaglutide); BI/Lilly’s Tradjenta (linagliptin); and Merck’s Janumet (sitagliptin and metformin) and Janumet XR (sitagliptin and extended-release metformin). The negotiated discounts announced in November 2025 ranged from 71-85%. See the full table in the appendix.

Drug prices were also negotiated under Most-Favored-Nation policy

Separately, the US government is negotiating drug prices under the Most-Favored Nation policy. In May 2025, the Trump Administration signed an executive order requiring pharmaceutical companies to align drug prices in the US with those in other developed nations. The executive order was first issued on a voluntary basis, with reinforcement planned if progress was not made.

In November 2025, the White House announced an agreement to offer GLP-1 RAs (Mounjaro, Zepbound, Ozempic, and Wegovy) at $245 per month through Medicare and Medicaid, for which beneficiaries will have a co-pay of $50 per month. State Medicaid programs will be able to access these medications at the same price. The new price changes are expected to take effect by mid-2026. These drugs will also be sold at discounted prices on TrumpRx, the government’s direct-to-consumer platform, starting in 2026. Wegovy and Wegovy pill will be sold at $350 and $150 per month, respectively, while Zepbound and orforglipron (upon approval) will be priced at $346 per month.

Pharmaceutical companies continue to enter Most-Favored-Nation agreements with the government – lowering drug costs for insulin, DPP-4 inhibitors, PCSK-9 inhibitors, and more. See appendix below. 

Close Concerns’ Questions

1. How much would the MDPNP negotiations affect out-of-pocket costs for Medicare beneficiaries?
2. How will CMS and pharmaceutical companies price drugs that have been negotiated through both MDPNP and Most-Favored Nation policy? For example, Ozempic and Wegovy are set to cost $350 per month starting in 2027 under MDPNP, while MFN pricing sets the drugs at $245 per month. Which will take precedence?
3. How does the government anticipate protecting negotiated drug prices amid lawsuits filed by pharmaceutical companies?

-- by Kat Moon, Monica Oxenreiter, and Kelly Close

Appendix

Table 1: Negotiated Prices for Diabetes and Obesity Medications