Medicare's 2027 Negotiated Drug Prices: What You'll Actually Pay for Ozempic, Wegovy, and 13 Other Drugs

Starting January 1, 2027, Medicare pays a new, sharply lower price for 15 of the most expensive drugs on Part D — the second round of prices set by the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act. The headline drug is Ozempic, cut from a list price of about $959 to a negotiated price of about $274 for a 30-day supply. But the list also includes the closely related weight-loss drug Wegovy, four cancer therapies, blockbuster inhalers, and treatments for diabetes, IBS, psoriasis, and movement disorders. Together these 15 drugs accounted for roughly $42.5 billion in Medicare Part D spending in 2024 across about 5.3 million enrollees.

What none of the headlines tell you is what your copay will actually look like on January 2, 2027, or whether the drug you take is covered for your condition, or how any of this interacts with the $2,100 Part D out-of-pocket cap that's already in place. Those are the parts worth walking through.

The second-cycle list, announced by CMS and finalized in late 2025 with all 15 manufacturers agreeing to participate, covers Part D drugs that were among Medicare's biggest single-drug expenditures. The average discount off list is roughly 55%; the biggest single cut is for Ozempic and the other semaglutide products at about 71%.

CMS's official infographic and the Federal Register notices are the source of truth on the exact per-drug maximum fair prices; the numbers above focus on the semaglutide products because they drove almost all of the press coverage and affect the largest number of people.

This is the point that trips almost everyone up. A "maximum fair price" of $274 for Ozempic is not the same as a $274 copay. What actually happens:

1. The pharmacy bills your Part D plan at the negotiated price. Your plan can't pay more than $274 for a 30-day Ozempic prescription, and the manufacturer can't charge more.
2. Your plan applies its own cost-sharing rules. Depending on the tier the drug sits on for your plan, you might pay a flat copay (say $47 or $110) or a coinsurance percentage (say 25% of $274, which is about $69).
3. Your out-of-pocket contribution counts toward the annual cap. In 2026 that cap is $2,100; CMS has not yet finalized the 2027 number, but it's indexed to Part D spending growth and typically only rises modestly.
4. Once you hit the cap, you pay $0 for covered drugs for the rest of the year — including these 15.

The practical upshot: if you take Ozempic and had been paying full price after a manufacturer coupon, your annual cost falls dramatically. If your plan already covered Ozempic and you were paying a fixed copay, the change will be smaller — but the plan pays less, which shows up over time as lower Part D premiums and slower cap growth.

The Wegovy line item deserves its own paragraph. Traditional Medicare Part D is prohibited by statute from covering drugs used solely for weight loss, and that hasn't changed. What changed is that Wegovy has FDA approval for reducing cardiovascular risk in people with obesity or overweight who already have heart disease, and Medicare Part D does cover it for that indication.

So the practical rule is:

• If you have Medicare, obesity, and established cardiovascular disease and your doctor prescribes Wegovy for cardiovascular risk reduction, your Part D plan is required to cover it — and starting January 1, 2027, at the negotiated price of about $385 for higher doses.
• If you have Medicare and want Wegovy purely for weight loss, Part D still won't cover it, and the $385 negotiated price does not apply to you. You'd pay cash or shop for a compounded alternative.

For more on how appeals work when a plan denies a covered drug, see our guide on how to appeal a prior authorization denial in 2026.

The Inflation Reduction Act put a hard annual out-of-pocket cap on Medicare Part D — $2,000 in 2025, $2,100 in 2026, and a similar-magnitude number in 2027. Once your total spending on covered Part D drugs reaches the cap, your plan pays 100% of the negotiated price for covered drugs for the rest of the calendar year.

Two things worth knowing about how the negotiated prices interact with the cap:

1. The clock resets each January 1. If you're a cancer patient on Ibrance or Calquence, you almost certainly hit the cap early in the year — but a lower underlying price means less total dollar volume flowing through the system before you get there, which slightly lowers plan premiums for everyone.
2. The Medicare Prescription Payment Plan lets you smooth costs. You can opt in to have your Part D cost-sharing spread across the calendar year in monthly installments at no interest. That's especially useful if you'd otherwise hit a $600 January copay on an expensive drug before you've had a chance to plan around it.

If you want to see what your total plan cost might look like next year, our Plan Cost Calculator can walk you through premium plus expected drug spending, and the Drug Cost Finder gives you a per-drug estimate.

The negotiated price applies only to Medicare Part D. If you're covered by any of the following, none of this changes what you pay today:

• An employer group health plan (unless the plan explicitly benchmarks to Medicare prices, which is rare).
• A Marketplace ACA plan. Your pharmacy benefit manager negotiates separately with manufacturers; you're on that price, not Medicare's.
• Medicaid. Medicaid already gets significant statutory rebates and best-price protections separate from the IRA program.
• The VA or TRICARE. Federal price rules for those programs are different.
• Cash pay without insurance. The manufacturer's list price, minus any coupon or discount card, is what you pay.

This is worth stating clearly because coverage of the negotiated prices has been broad enough that some working-age people assume their Ozempic will drop to $274 next year. It won't, unless they're on Medicare.

If you're on a Marketplace plan and drug cost is your biggest concern, our guide on how to lower prescription drug costs in 2026 walks through what does actually work: formulary tier appeals, manufacturer patient-assistance programs, GoodRx and Mark Cuban Cost Plus for uninsured fills, and when to switch to a plan with better drug coverage.

1. Check whether your drug is on the list. If it isn't (say you take Trulicity or Mounjaro, both of which are not in this cycle), the negotiated prices won't help you next year. You may want to look at whether switching to a listed drug in the same class makes sense with your doctor.
2. Look at your 2027 plan choices during open enrollment (October 15 – December 7, 2026). Because plans will re-price around the new lower drug costs, both premiums and formulary tiers are likely to move. Compare your specific drug basket in Medicare Plan Finder.
3. If you take a listed drug and pay a high copay, opt into the Medicare Prescription Payment Plan so a big January bill doesn't hit all at once.
4. Confirm coverage for Wegovy is being written on the cardiovascular indication if that's why you're on it. Diagnosis code matters.
5. Watch for third-cycle drug selections announced by CMS in early 2026 — those prices take effect in 2028 and will include the first Part B (physician-administered) drugs.

January 1, 2027 is the day the second-cycle Medicare Part D negotiated prices go live, and for the roughly 5.3 million beneficiaries who take one or more of the 15 drugs on the list, it's a meaningful cut — biggest for Ozempic, Rybelsus, and Wegovy at about a 71% discount, and material for the four cancer drugs and the two blockbuster inhalers. But the negotiated price is not your copay, weight-loss-only Wegovy is still not covered, and none of this changes what you pay if you're on employer or Marketplace insurance. The right move over the next six months is to check the list against your prescriptions, use open enrollment to re-shop your plan against the new prices, and opt into the payment plan if your cost-sharing lands unevenly across the year.