CMS selects 15 drugs for next Medicare price negotiations, including Botox; prices to take effect in 2028

The Centers for Medicare & Medicaid Services (CMS) announced a new list of 15 high-cost prescription drugs selected for the third cycle of Medicare’s drug price negotiation program, expanding a policy effort aimed at lowering costs for seniors and people with disabilities. The selection includes Botox and other widely used therapies for conditions ranging from cancer and autoimmune disease to HIV and diabetes.

CMS said negotiations with participating manufacturers will take place during 2026, and the resulting negotiated prices are scheduled to become effective on January 1, 2028. The agency also said that, for the first time in this cycle, the selection includes drugs payable under Medicare Part B—broadening the program beyond prior rounds that focused heavily on Part D.

In its announcement, CMS said the selected drugs accounted for about $27 billion in total spending across Medicare Parts B and D, roughly 6% of total Part B and Part D spending. The agency also released a list of 50 “negotiation-eligible” drugs by combined expenditures and said the chosen medicines represent the 15 highest-spending drugs on that list.

The selected list includes: Anoro Ellipta, Biktarvy, Botox (and Botox Cosmetic), Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz (and Xeljanz XR), and Xolair. CMS framed the choices as a transparency step intended to show how eligibility criteria and spending data drive selection.

The move is the latest phase of a program created under the Inflation Reduction Act, which authorized Medicare to negotiate prices for certain high-spending drugs. While the policy’s structure remains politically contested, it has become one of the most closely watched levers in US health policy because of its potential impact on out-of-pocket costs, premiums, and federal spending.

For patients, the practical implications depend on how negotiations play out and how plans implement the new prices once they take effect. CMS says negotiated prices must be made available to eligible individuals and to the entities that dispense the drugs. The timing matters: negotiations in 2026 set the stage for prices in 2028, so near-term pharmacy costs may not change immediately for the newly selected list.

The inclusion of Botox drew attention because it is widely known for cosmetic use but also has Medicare-covered indications, such as certain chronic conditions. The broader list includes expensive specialty therapies often used long-term, meaning even modest reductions can translate into significant aggregate savings if access is maintained.

Next steps include manufacturer participation decisions and the negotiation process itself, which will set the final “maximum fair prices.” Health insurers, drugmakers, patient advocates, and policymakers are expected to closely monitor the talks, as they may influence future rounds and how quickly the program expands to additional drugs.