TABLE 1.
Drugs Anticipated to Face Medicare Price Negotiation, 2026-2028
| Rank/part | Brand name | Generic name | Manufacturer | Spending in 2020a, $ | Years since approvalb | Expected loss of exclusivityc (by year) | Minimum discountd, % | CBO-estimated annual savingse, $ | |
|---|---|---|---|---|---|---|---|---|---|
| Subject to negotiation in 2026 | |||||||||
| 1 | D | Eliquis | Apixaban | BMS/Pfizer | 9,936,069,814 | 13.0 | 2028 | 25 | 3.7 billion |
| 2 | D | Xarelto | Rivaroxaban | Janssen Pharm. | 4,701,314,805 | 14.5 | 2027 | 25 | |
| 3 | D | Januviaf | Sitagliptin phosphate | Merck Sharp & D | 3,865,087,773 | 19.2 | 2026 | 60 | |
| 4 | D | Imbruvica | Ibrutinib | Pharmacyclics | 2,962,909,304 | 12.1 | 2033 | 25 | |
| 5 | D | Jardiance | Empagliflozin | Boehringer Ing. | 2,376,166,292 | 11.4 | 2028 | 25 | |
| 6 | D | Enbrel | Etanercept | Amgen | 2,154,714,778 | 27.2 | 2029 | 60 | |
| 7 | D | Symbicort | Budesonide/formoterol | Astrazeneca | 2,135,408,250 | 19.5 | 2028 | 60 | |
| 8 | D | Ibrance | Palbociclib | Pfizer US Pharm | 2,108,937,188 | 10.9 | 2034 | 25 | |
| 9 | D | Xtandi | Enzalutamide | Astellas Pharma | 1,968,567,948 | 13.4 | 2027 | 25 | |
| 10 | D | Breo Ellipta | Fluticasone/vilanterol | Glaxosmithkline | 1,504,155,910 | 12.7 | 2030 | 25 | |
| Total 2026 drugs | 33,713,332,062 | ||||||||
| Subject to negotiation in 2027 | |||||||||
| 1 | D | Trelegy Ellipta | Fluticasone/umeclidinium/vilanterol | Glaxosmithkline | 1,487,802,308 | 9.3 | 2027 | 25 | 8.3 billion (2027 savings from drugs negotiated in 2026-2027) |
| 2 | D | Ozempic | Semaglutide | Novo Nordisk | 1,455,812,267 | 9.1 | 2031 | 25 | |
| 3 | D | Invega Sustenna | Paliperidone palmitate | Janssen Pharm. | 1,372,610,289 | 17.4 | 2031 | 60 | |
| 4 | D | Jakafi | Ruxolitinib | Incyte Corporat | 1,296,674,522 | 15.1 | 2028 | 25 | |
| 5 | D | Tradjenta | Linagliptin | Boehringer Ing. | 1,288,663,293 | 15.7 | 2027 | 25 | |
| 6 | D | Ofev | Nintedanib esylate | Boehringer Ing. | 1,157,563,828 | 12.2 | 2029 | 25 | |
| 7 | D | Spirivag | Tiotropium bromide | Boehringer Ing. | 1,153,453,863 | 22.9 | 2030 | 60 | |
| 8 | D | Linzess | Linaclotide | Allergan Inc. | 1,144,468,128 | 14.4 | 2033 | 25 | |
| 9 | D | Anoro Ellipta | Umeclidinium/vilanterol | Glaxosmithkline | 1,002,343,776 | 13.1 | 2030 | 25 | |
| 10 | D | Creon | Lipase/protease/amylase | Abbvie US LLC | 960,235,542 | 17.8 | 2031 | 60 | |
| 11 | D | Epclusa | Sofosbuvir/velpatasvir | Gilead Sciences | 867,053,907 | 10.5 | 2034 | 25 | |
| 12 | D | Xifaxan | Rifaximin | Salix Pharmaceu | 844,562,189 | 22.6 | 2027 | 60 | |
| 13 | D | Spiriva Respimatg | Tiotropium bromide | Boehringer Ing. | 804,565,194 | 12.3 | 2030 | 25 | |
| 14 | D | Ingrezza | Valbenazine tosylate | Neurocrine Bios | 792,681,813 | 9.7 | 2038 | 25 | |
| 15 | D | Janumet | Sitagliptin phos/metformin hcl | Merck Sharp & D | 791,886,114 | 19.7 | 2026 | 60 | |
| Total 2027 drugs | 16,420,377,033 | ||||||||
| Subject to negotiation in 2028 | |||||||||
| 1 | B | Keytruda | Pembrolizumab | Merck Sharp & D | 3,500,947,569 | 13.3 | 2028 | 25 | 17.5 billion (2028 savings from drugs negotiated in 2026-2028) |
| 2 | D | Trulicityh | Dulaglutide | Eli Lilly & Co. | 3,284,873,062 | 13.3 | 2027 | 25 | |
| 3 | B | Opdivo | Nivolumab | BMS | 1,586,591,103 | 13.0 | 2028 | 25 | |
| 4 | D | Biktarvy | Bictegravir/emtricitabine/tenofovir | Gilead Sciences | 1,775,846,507 | 9.9 | 2036 | 25 | |
| 5 | D | Genvoya | Elvitegravir/cobicistat/emtricitabine/tenofovir | Gilead Sciences | 755,819,244 | 12.2 | 2032 | 25 | |
| 6 | D | Triumeq | Abacavir/dolutegravir/lamivudine | Viiv Healthcare | 738,986,222 | 13.4 | 2029 | 25 | |
| 7 | D | Farxiga | Dapagliflozin | Astrazeneca | 736,787,564 | 14.0 | 2030 | 25 | |
| 8 | D | Tivicay | Dolutegravir | Viiv Healthcare | 656,037,862 | 14.4 | 2029 | 25 | |
| 9 | D | Lumiganh | Bimatoprost | Allergan Inc. | 633,540,096 | 17.4 | 2027 | 60 | |
| 10 | D | Acthar | Corticotropin | Mallinckrodt Ph | 621,884,161 | 77.6 | NA | 60 | |
| 11 | D | Incruse Ellipta | Umeclidinium | Glaxosmithkline | 605,138,195 | 13.7 | 2030 | 25 | |
| 12 | D | Pradaxah | Dabigatran | Boehringer Ing. | 599,577,175 | 17.2 | 2027 | 60 | |
| 13 | D | Brilinta | Ticagrelor | Astrazeneca | 588,513,924 | 16.5 | 2030 | 60 | |
| 14 | D | Xeljanz XR | Tofacitinib citrate | Pfizer | 575,315,148 | 11.9 | 2034 | 25 | |
| 15 | D | Invokana | Canagliflozin | Janssen Pharm. | 571,448,119 | 14.8 | 2031 | 25 | |
| Total 2028 drugs | 17,231,305,951 | ||||||||
| Total 2026-2028 drugs | 67,365,015,046 | 29.5 billion | |||||||
a Estimates represent gross Part D spending in 2020 for Part D drugs and gross Part B spending in 2020 for Part B drugs. Spending estimates were obtained from the Medicare spending dashboards.
b Calculated as the time between drug approval and January 1 of the year that the drug is first expected to be subject to negotiation.
c Expected loss of exclusivity was estimated as the latest reported drug substance or drug product patent expiry date, superseded by any publicly announced patent settlement date. 17-19
d Beginning in 2030, drugs from 12 to 15 years of age will be subject to a minimum 35% discount.
e Annual savings include ongoing savings from negotiated prices achieved in prior years.
f Although the entry of generic sitagliptin is expected in mid-2026, this will not disqualify Januvia from negotiation in 2026, as a generic product must have been marketed for at least 9 months prior to the implementation year for the reference product to be ineligible for negotiation.
g Spiriva and Spiriva Respimat were considered different products as they have different application numbers.
h Patent protection anticipated to expire after the first quarter of 2027, so any approved generics or biosimilars would not meet the 9-month marketing requirement prior to 2028.
BMS = Bristol Myers Squibb; CBO = Congressional Budget Office; NA = not applicable.